Mental Health

ISSUES OF MENTAL HEALTH

THE CURRENT IRISH DEBATE

113 PSYCHIATRISTS OPPOSE ABORTION PROPOSAL

On 24th April 2013 113 psychiatrists have signed a statement saying that legislation, which would allow for abortion as a treatment for threat of suicide, has no basis in medical evidence.

Four leading psychiatrists who carried out the survey of around 300 psychiatrists in the country. They are Dr Martin Mahon, Connolly Hospital, Dr Bernie McCabe, Navan Hospital, Dr Richelle Kirrane, Connolly Hospital and Prof Patricia Casey of the Mater Hospital. Of those who replied, 14 of the doctors disagreed with the statement.

Dr McCabe said: “I am not surprised that so many of our colleagues agree that the proposed legislation is flawed. As members of the medical profession, we have a duty to our patients to adopt best practice and an evidence-based approach to everything we do.

“The fact is that there is no evidence that abortion is a treatment for suicidality in pregnancy and may in fact be harmful to women. The Government must take this into account and reconsider its proposals.”

She said: “In total, 302 letters were sent to consultant psychiatrists there was over a 40pc response. Doctors were given the option to sign their names or reply anonymously. Almost 90pc of respondents agreed with the statement.

Text of the Statment:

As practicing psychiatrists we are deeply concerned at the Government’s stated plan to legislate along the lines of the X-Case, as this will mean legislating for suicidality.

We believe that legislation that includes a proposal that an abortion should form part of the treatment for suicidal ideation has no basis in the medical evidence available.

We as psychiatrists are being called upon to participate in a process that is not evidence based and we do not believe that this should be asked of the profession.

Any proposal being considered by the Government must be based on a rigorous appraisal of the available psychiatric research and medical evidence.

DEFINITION OF MENTAL HEALTH

The term "mental health," as commonly used, is synonymous with the United Nations' definition of "health," which means social, emotional, and economic well-being, as judged by the person him/herself. This is a broad, sweeping definition which soars far beyond and cannot be equated with "mental health," as medically defined.

As early as 1971, Dr. Louis Hellman, Deputy Assistant Secretary of the Department of Health, Education, and Welfare (HEW), who was strongly pro-abortion, said (at Columbia Women's Hospital, Washington, DC), that the requirement of a psychiatrist's permission for abortion was a "gross sham."Washington Post, Nov. 25, 1971

This reference was made in spite of (or because of), the fact that, of a total 14,717 hospital abortions performed in California (Nov. '67-Sept. '69), 90% were for mental health purposes.California Dept. of Public Health, Third Annual Report to California Legislature, 1970

In New York, where the law did not require such a subterfuge, only 2% of the abortions reported for 1970 were performed for "mental health" reasons. Every state or nation that has legalised abortion for "health" has abortion-on-demand.

Requirement of psychological treatment

Although there is undoubtedly a great need for more research on the psychological consequences of induced abortion, it is clear that women experience varying degrees of emotional distress after the procedure.

The evidence outlined below shows that there are particular risk factors associated with the increased likelihood of developing severe and/or prolonged psychological sequelae as a result of having an abortion. Emotional harm from abortion is more likely when one or more of the following risk factors are present: (55)

1. prior history of mental illness2. immature interpersonal relationships3. unstable, conflicted relationship with one's spouse4. history of a negative relationship with one's mother5. ambivalence regarding the abortion6. religious and cultural background hostile to abortion7. single status, especially if no born children8. adolescent9. second trimester abortion10. abortion for genetic reasons11. coercion to abort12. prior children13. maternal orientation

Those features which are likely to be of significance in the Irish clinical situation have been highlighted. Ignorance is no defence where negligence exposes patients to an event which may have life-long implications for her and those close to her. Ultimately, the expectant mother will make the decision, but she has the absolute right to be informed of the likely psychological effects of her decision, with the resultant need for longer-term psychiatric or psychological intervention.

Recognised Effects of Induced Abortion

In a study of post-abortion patients only eight weeks after their abortion, researchers found the following results; (56)

A 5-year retrospective study from Canada (57) found significantly greater use of medical and psychiatric services among aborted women. Most significant was the finding that 35% of aborted women made visits to psychiatrists, as compared to 3% of women who had not had abortions.

Danish Study

A large study of all pregnant women throughout the entire population of Denmark was conducted in 1985 and discussed in The Rawlinson Report (1994). (58) The researchers in this study compared women less than three months after an abortion with pregnant women who declined abortion.

They found that psychiatric hospitalisation was higher amongst the post-abortion women than among those who declined abortion and delivered. This very comprehensive study made it quite clear that women who undergo an abortion are very likely to develop psychological complications.

Very little information about the research findings on the adverse psychological effects of abortion is shared with women who are considering the procedure. Again this raises the issue of "informed consent." By withholding readily available information, can the woman's carer be acting in her best interests?

In the Irish context, particularly with our recent history of court-directed abortions for vulnerable young girls, we should pay close heed to the words of the World Health Organization:

"Serious mental disorders arise more often in women with previous mental problems. Thus, the very women for whom legal abortion is considered justified on psychiatric grounds are the ones who have the highest risk of post-abortion psychiatric disorders." (59)

References

Requirement of Psychological Treatment

55. Zolese G, Blacker CVR, "The psychological complications of therapeutic abortion," British Journal of Psychiatry, 1992, 160,742-956. Ashton, "The Psychosocial Outcome of Induced Abortion," British Journal of Obstetrics and Gynaecology, 87:1115-112257. Badgley et al, "Report of the Committee on the Operation of the Abortion Law," Ottawa, Canada, Supply and Services, 1977, p 313-32158. "The Rawlinson Report: The Physical and Psychosocial effects of abortion in Women (1994). A report by the Commission of Inquiry into the Operation and Consequences of the Abortion Act," London, HMSO59. Official Statement of The World Health Organisation, 1970

Substance abuse and relationship problems

ALCOHOL / DRUG ABUSE

The use of drugs and alcohol by women following an abortion is not uncommon. They are usually used as a means of ignoring or forgetting unsettled psychological issues resulting from the abortion. Some post-abortion researchers see substance abuse as part of the woman's attempt to cope with her decision to abort.

The Brende study describes this coping strategy as follows: "...victims develop repetitive symptoms with splitting and dissociation as mental defenses, often using alcohol, tranquilizers and other substances." (72)

In her Ph.D. thesis, Anne Catherine Speckhard (73) interviewed 30 post-abortive women and found that 60% developed an increased intake of alcohol while 58% reported drug use. A majority of the women believed their first heavy use of drugs or alcohol to be associated with stress induced by the abortion.

Only 10% reported any substance abuse before the abortion. The findings of this research are based on the assumption that substance abuse is a response to distress, lack of personal control or a lack of positive self-esteem.

Speckhard's findings indicate that, among women who have suffered from negative post-abortion reactions, most of those who engaged in substance abuse believed they did so in an attempt to cope with abortion related stress.

The South African Medical Journal found that 11% of the post-abortive women they interviewed developed an increase in the use of alcohol and tobacco while 16% had increased their use of tranquilizers. (74)

David C Reardon also examined the link between abortion and subsequent substance abuse. (74a) He notes that

"Women who aborted a first pregnancy were 3.9 times more likely to report substance abuse than women who carried to term."

These findings were based on a national randomised sample of 700 women participating in a reproductive history survey.

Excluded were women who had engaged in substance abuse prior to their first pregnancy. This study found that for the women surveyed who were pregnant prior to a history of substance abuse, the rate of post-pregnancy substance abuse rose from 3.8% for women who did not abort to 14.6% for women who did abort their first pregnancy.

It is also likely that the risk of post-abortion substance abuse among women who undergo multiple abortions is even higher than the risk for women who experience only a single abortion. It is also reasonable to assume that post-abortion stress may further aggravate these problems among women with a prior history of substance abuse.

SMOKING

There have been numerous studies done in relation to smoking and pregnancy in general. J Lydon (75) interviewed 57 women, some of whom had undergone an abortion and some of whom had carried to term. Lydon and colleagues found that those women continuing the pregnancy smoked fewer cigarettes, while those who had abortions reported no change or an increase in their smoking behaviour.

The Journal of the American Medical Association studied women patients of Boston Hospital and found smoking rates of 31.7% for women with no prior induced abortion, 40.3% with one prior abortion and 51.7% with two or more prior abortions. (76) Thomas and Tori found similar results in that women who aborted were more likely to have a history of substance abuse. (77)

EATING DISORDERS

There is a need for more research to be conducted on the connection between abortion and subsequent eating disorders. Abortion has, however, been linked to eating disorders such as bingeing and starvation. A report in a 2000 edition of the International Journal of Eating Disorders found that there was an elevated incidence of eating disorders among women who had had abortions which was not found among women with live births or miscarriages. (78)

RELATIONSHIP PROBLEMS

Abortion can have a major impact on the relationship a woman has with the father of the aborted baby and also with family members and other children. The incidence of marital breakdown and relationship dissolution after an abortion is between 40-75%. (79) Often, when if a young girl is forced into having an abortion by her parents, there is a similar breakdown in the parent-child relationship.

Abortion can also have a negative effect on relationships with future children. Some women report being emotionally frozen and find it difficult to bond maternally with their children. In fact, the Canadian Journal of Psychiatry (79a) reported a condition known as ‘Post-Abortion Survivors Syndrome' which can manifest itself in the future children of a post-abortion woman, negatively affecting the parent-child relationship.

In the report entitled Post-abortion Trauma, (80) Dr. Vincent Rue remarks; "Abortion never occurs within a relationship vacuum. Whether the abortion is shared or not, many significant others can be impacted." There is a general tendency to assume that the only inter-personal relations affected are those of the woman and the father of her child. Though these may seem the most likely, other relationships can be severely strained as well.

MARITAL BREAKUP

As detailed below, reports find that between 40- 50% of relationships are negatively affected by abortion. These relationship dissolutions can be attributed to several factors. Some arise from the abortion experience itself, while others arise from the reactions of the man in the relationship. Both of these factors, and indeed many others, can produce a breakdown of intimacy in the relationship and cause it to fail.

In Sherman's study, the author found that 48% of his sample reported that their relationship with their spouse had been changed dramatically following the abortion. (81)

Barnett et al (82) studied women from steady relationships who had abortions and subsequently separated. The authors found that in 80% of the relationships the separation was initiated by the woman. Also 60% reported a connection between the abortion and subsequent separation. None of these couples were married at the time of the abortion nor did any marry each other after the event.

In 1993, Teichman (83) found that there was a positive link between depression in women who had had abortions and their relationship with their partners. Interestingly, the author suggested that the nature of a woman's relationship can affect the level of depression she experiences. Women who were involved in committed relationships found it easier to cope, whereas unmarried women reported significantly higher levels of anxiety and depression.

RELATIONSHIP BETWEEN ABORTING MOTHER AND LIVING CHILDREN

In Raphael's book, The Anatomy of Bereavement, (84) the author maintains that "the pattern of grief and mourning [for induced abortion] is not dissimilar to that for spontaneous abortion, except that suppression and inhibition of grief and mourning are much more likely."

After an abortion some women find it difficult to react in a compassionate, loving way to their living children and to those who are born following the abortion. Some researchers believe that this can be the result of ongoing depression or the fact that children are a constant reminder of the aborted child.

One such case is discussed by Janet Mattinson (85) in her report The Effects of Abortion on a Marriage. In this report the author refers to a couple (who had a previous abortion) whose baby gave them great pleasure for eight months after it was born, but who returned to therapy when the wife turned against the child and had a nervous breakdown.

Similarly Brown et al studied letters from women who said they had experienced negative post-abortion reactions and in 13.3% of the cases they reported what the authors call "phobic responses to infants." (86)